EP2643477A2 - Multimarker-tafel - Google Patents

Multimarker-tafel

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Publication number
EP2643477A2
EP2643477A2 EP11788824.8A EP11788824A EP2643477A2 EP 2643477 A2 EP2643477 A2 EP 2643477A2 EP 11788824 A EP11788824 A EP 11788824A EP 2643477 A2 EP2643477 A2 EP 2643477A2
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EP
European Patent Office
Prior art keywords
expression
pbc
genes
gene
malignant
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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EP11788824.8A
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English (en)
French (fr)
Inventor
Robert Zeillinger
Dietmar Pils
Dan Cacsire Castillo Tong
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OncoLab Diagnostics GmbH
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OncoLab Diagnostics GmbH
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Priority to EP11788824.8A priority Critical patent/EP2643477A2/de
Publication of EP2643477A2 publication Critical patent/EP2643477A2/de
Withdrawn legal-status Critical Current

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    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6876—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes
    • C12Q1/6883—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material
    • C12Q1/6886—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material for cancer
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6809—Methods for determination or identification of nucleic acids involving differential detection
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
    • C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
    • C12Q1/6876—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q2600/00—Oligonucleotides characterized by their use
    • C12Q2600/112—Disease subtyping, staging or classification
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
    • C12Q2600/00—Oligonucleotides characterized by their use
    • C12Q2600/166—Oligonucleotides used as internal standards, controls or normalisation probes

Definitions

  • the invention refers to a multimarker panel for diagnosing malignant ovarian tumor disease.
  • a tumor marker also called marker or biomarker
  • tumor markers there are many different tumor markers, each indicative of a particular disease process, and they are used in oncology as a diagnostic or prognostic marker or used to monitor cancer therapy.
  • tumour-specific markers are overexpressed in tumor tissue compared to normal tissue and therefore determined in tumor specimens.
  • the expression of tumour-specific genes in cancerous tissue is sometimes investigated to gain information about prognostic markers and molecular targets for diagnosis or chemical and/or immunological therapy.
  • ovarian cancer One of the most deadly malignant diseases in women is ovarian cancer.
  • the high risk of dying is probably due to late diagnosis, i. e. 67% of patients are diagnosed with advanced disease, 15 percentage points more than in pancreatic cancer, known to be diagnosed frequently at advanced stages.
  • Approximately 14,600 deaths (5% of all cancer types) were estimated in 2009 only for the United States of America, rendering this type of tumor to the fifth frequent cause of cancer death in females.
  • the five-year overall survival (OS) rate is only 46% among all stages. Patients with stage I disease have a five-year OS rate of more than 90%, whereas patients with advanced disease less than 30%.
  • One reason for the low five-year OS rate is the fact that ovarian cancer presents with few, if any, specific symptoms. Therefore markers for early detection of ovarian cancer could improve OS. Up to now no screening markers are recommended or routinely used for early detection of ovarian cancer.
  • CA-125 is a coelomic epithelial antigen produced by mesothelial cells in the peritoneum, pleural cavity and pericardium. Serum CA-125 levels are measurably increased in about 80% of patients with ovarian cancer, to a lesser extent in patients with early stages. Sensitivity of CA-125 is lower than 60% in early stages. But serum concentrations can be elevated by a number of common benign tumors.
  • gynecologic conditions including endometriosis, leiomyomas, congestive heart failure and liver cirrhosis.
  • serum concentrations of CA-125 are higher in
  • CA-125 is even discussed as a therapeutic target.
  • CA-125 One of the possibilities to increase the sensitivity and specificity of CA-125 is to expand this single marker to a marker panel, i. e. add other serum markers and build a statistical model to detect ovarian cancer.
  • Yurkovetsky et al. described a four serum marker panel, HE4, CEA, VCAM-1 , and CA-125, for early detection of ovarian cancer.
  • a model derived from these four serum markers provided a diagnostic power of 86% sensitivity for early stage and 93% sensitivity for late stage ovarian cancer at 98% specificity (Yurkovetsky Z et al. J Clin Oncol 2010;28: 2159-66).
  • Hausler et al. (British Journal of Cancer (2010) 103, 693-700) describe a characteristic miRNA fingerprint in peripheral blood of ovarian cancer patients employing a cellular fraction, referring to circular tumor cells, stromal and myeloid progenitors and hematopoietic cells with a low predictive power.
  • US2010/0216137 A1 discloses a method of gene expression profiling for identification, monitoring and treatment of avarian cancer, employing a sample providing a source of RNAs.
  • a sample may be whole blood or a population of cells or tissue from a subject.
  • PBC peripheral blood cells
  • tissue biopsies Although expression profile analysis of tissue biopsies have identified the presence of tumor-associated transcriptomes that may be used to diagnose cancer and to distinguish between malignant or benign disease, the required biopsy of tissue makes such methods of diagnosis unattractive. Compared to tissue biopsies, cells in the peripheral blood, in particular circulating PBCs, are much more accessible.
  • the object of the present invention was to find new prognostic biomarkers to diagnose malignant ovarian tumor disease in a subject.
  • the present invention refers to a method of diagnosing a malignant ovarian tumor disease in a subject, which comprises
  • PBC peripheral blood cells
  • a multimarker gene panel comprising at least NEAT1 , BC037918, C1 orf63, PRIC285, OSM, and optionally further gene or protein markers,
  • comparing to a reference value e.g. derived from non-cancerous patients or healthy controls
  • the differential expression being indicative of a malignant ovarian tumor.
  • the sample is obtained from a blood fraction enriched in white blood cells, including granulocytes and optionally lymphocytes.
  • the PBC fraction is used, wherein as white blood cells a majority of granulocytes is contained.
  • An exemplary blood fraction is obtained by density fractionation, such as buoyant one or more-step gradient procedures to obtain a fraction with a high density, which contains the granulocytes and lymphocytes, e.g. as obtained by a sample preparation method as described in Brandt et a.
  • a PBC fraction which is a white blood cell fraction containing granulocytes or a fraction wherein a majority of the white blood cells are granulocytes.
  • other white blood cells which are not granulocytes may be contained, e.g. lymphocytes and monocytes.
  • PBMC may be contained.
  • Such PBC fraction is preferred that is obtained upon reducing the content of potentially present epithelial cells, including circulating tumor cells, which includes (partial or quantitative) removal or depletion of epithelial cells.
  • the preferred method employs a sample, which is obtained from a fraction containing blood cells, in particular peripheral white blood cells, e.g. a blood sample, optionally depleted from epithelial cells and/or enriched in granulocytes or
  • lymphocytes Specifically, the expression of at least one of the further genes B4GALT1 , CCR2, CFP, ZNF419, PAPOLG, NOXA1 , DIS3 and/or AP2A1 is determined.
  • the expression of the markers NEAT1 , BC037918, C1 orf63, PRIC285, OSM, DIS3 and CCR2, or at least these markers is determined, possibly in combination with further genes markers and/or protein markers.
  • the expression of at least NEAT1 , BC037918, C1 orf63, PRIC285, OSM, B4GALT1 , CCR2, CFP, ZNF419, PAPOLG, NOXA1 , DIS3 and AP2A1 is determined.
  • the expression of at least one of the further house-keeping genes RPL21 , RPL9 and/or SH3BGRL3 is determined as internal control, preferably at least two or three of these internal control genes. Any other house-keeping gene may be used as internal control for the purpose of the invention.
  • the nucleic acid and/or protein expression is determined.
  • the nucleic acid expression is determined, which is indicative for the gene expression, preferably the mRNA.
  • the mRNA of the individual genes or markers in the PBC sample as determined either quantitatively or qualitatively, e.g. the differential expression, such as a differential expression, e.g. an increased or decreased expression, is indicative of malignant ovarian tumor disease, such as ovarian cancer.
  • the method can be combined with any other diagnostic method for determining ovarian cancer, specifically another diagnostic method selected from a screening method for serum proteins or proteins from other bodily fluids, which are indicative of ovarian cancer.
  • the nucleic acid or protein expression of the serum or plasma proteins or proteins from other bodily fluids is determined.
  • the method can be combined with another diagnostic method selected from determination methods for clinical
  • ovarian cancer such as transvaginal ultrasound.
  • methods according to the invention encompass e.g. a method for determining the nucleic acid expression, such as mRNA, of genes in the PBC sample according to the invention, e.g. the multimarker panel according to the invention,
  • a method for determining clinical paramerters, indicative of malignant ovarian tumor disease such as transvaginal ultrasound.
  • Such combinations may contribute to improve the diagnosis of malignant disease.
  • the serum proteins are selected from the group consisting of CA- 125, HE4, CEA, VCAM-1 , MIF, Leptin, Prolactin, OPN (osteopondin), IGF-II (IGF2), apolipoprotein A1 , transthyretin or truncated transthyretin, ITIH4, hepcidin, ⁇ 2- microglobulin, transferrin, CTAP3 and inter-alpha-trypsin inhibitor heavy chain H4, or a cleavage fragment thereof.
  • At least NEAT1 , BC037918, C1 orf63, PRIC285, OSM, and further at least MIF, Prolactin, CA125, Leptin and IGF-II are determined.
  • the gene markers NEAT1 , BC037918, C1 orf63, PRIC285 and OSM are determined in combination with the protein markers MIF, Prolactin, CA125, Leptin and IGF-II, possibly combined with further gene markers and/or protein markers.
  • At least NEAT1 , BC037918, C1 orf63, PRIC285, OSM, DIS3, CCR2, and further at least MIF, Prolactin, CA125, Leptin and IGF-II are determined.
  • the gene markers NEAT1 , BC037918, C1 orf63, PRIC285, OSM, DIS3 and CCR2 are determined in combination with the protein markers MIF, Prolactin, CA125, Leptin and IGF-II, possibly combined with further gene markers and/or protein markers.
  • BC037918, C1 orf63, PRIC285, OSM, B4GALT1 , CCR2, CFP, ZNF419, PAPOLG, NOXA1 , DIS3, AP2A1 are determined in combination with the protein markers MIF, Prolactin, CA125, Leptin, IGF-II and OPN, possibly combined with further gene markers and/or protein markers.
  • the expression is determined qualitatively and/or quantitatively, e.g. by Northern blot or other hybridization based methods, RT-qPCR, microarrays, ELISA, EIA, RIA, western blot, protein arrays, immunocytochemistry or immunohistochemistry methods.
  • Other methods of determining the expression of genes or non-coding sequences associated therewith, including any of corresponding RNA, such as mRNA, or DNA specimen, or else proteins, peptides, precursors or ligands are feasible.
  • Such expression or the expression level may be indicative of a malignant ovarian tumor.
  • the differential expression levels as compared to a reference may be determined.
  • the method provides for the prediction of malignant ovarian tumor even at an early stage, in particular of the FIGO I and/or II (l/ll) stage, with a specificity of at least 99%, preferably with a sensitivity of at least 70%, specifically at least 74%, more specifically with a sensitivity of at least 80%, at least 85%, at least 90% or even more than 95%. In preferred cases a sensitivity of 95.5-99% at a specificity of at least 99.5% can be reached.
  • the preferred method differentiates between a malignant ovarian tumor and a benign (e.g. ovarian cyst or cystadenoma) or low malignant potential (LMP) tumor (e.g. a borderline tumor).
  • a benign tumor as understood herein is a tumor that lacks the ability to metastasize.
  • the present invention provides for a set of reagents to determine the expression of a multimarker panel in a PBC fraction, which is at least consisting of NEAT1 , BC037918, C1 orf63, PRIC285, OSM, and optionally at least one of B4GALT1 , CCR2, CFP, ZNF419, PAPOLG, NOXA1 , DIS3 and/or AP2A1 , which is herein understood as the PBC multimarker panel.
  • the set according to the invention specifically comprises reagents to determine the individual markers of said panel.
  • reagents are comprised to determine mRNA of the individual markers.
  • the set according to the invention specifically may contain reagents for a limited number of individual markers of the PBC multimarker panel only.
  • such multimarker panel comprises less than 100 individual markers, more preferred less than 50 individual markers, even more preferred less than 40, or less than 30 or less than 20, or less than 10 individual markers.
  • the set comprises only those reagents of the PBC multimarker panel as necessary to determine a limited or the above specified individual markers only, specifically only those reagents as necessary to determine the PBC multimarker panel consisting of NEAT1 , BC037918, C1 orf63, PRIC285, OSM, and optionally at least one of B4GALT1 , CCR2, CFP, ZNF419, PAPOLG, NOXA1 , DIS3 and/or AP2A1 , optionally in
  • the set according to the invention further comprises means to prepare a PBC fraction.
  • means to prepare a PBC fraction include buffer or other auxiliary reagents or tools to enrich and/or fractionate white blood cells, cell lysis reagents, internal controls, negative controls, etc.
  • the preferred set further contains reagents for determining the expression of at least one of the RPL21 , RPL9, and/or SH3BGRL3 genes as internal control.
  • the set comprises primers, optionally together with probes, to perform the RT-qPCR analysis of the individual markers, optionally together with further tools to perform such analysis.
  • the set comprises probes to specifically hybridise with gene transcription products of the individual markers.
  • the invention refers to the use of the set in a method of diagnosing a malignant ovarian tumor disease in a subject, such as a method employing the PBC multimarker panel according to the invention, or a method according to the invention as described herein.
  • the invention provides for the use of a PBC- expression based test or method to improve a serum protein based test for diagnosing ovarian cancer, preferably a test to determine mRNA in a PBC fraction.
  • the PBC-expression based test is a method according to the invention or any other method employing the PBC multimarker panel according to the invention.
  • the invention provides for a method of determining the expression of at least one of the RPL21 , RPL9 and/or SH3BGRL3 genes, preferably at least two or three of them, in a PBC fraction such as used in the method according to the invention, of a subject, e.g. a human subject at risk of a disease, such as a malignant ovarian tumor disease like cancer, as normalization markers or internal control to quantify the expression of further genes other than the internal control genes, such as those which are indicative of a disorder or a disease by the respective overexpression/ upregulation or downregulation, e.g. to indicate or diagnose a disorder or disease, in particular malignant ovarian tumor disease like cancer.
  • Figure 1 Nucleotide sequence of BC037918 (SEQ ID 1 ): cDNA sequence information, human.
  • Figure 2 Nucleotide sequence of PRIC285 (SEQ ID 2): cDNA sequence information, transcript variant 1 , including other variants possibly used, human.
  • peripheral blood cells such as obtained from peripheral white blood cells or a PBC fraction enriched in white blood cells, specifically in samples from human subjects, isolated from subjects at risk of (malignant) ovarian tumor disease, and the
  • the present invention is directed to the utilization of at least one "transcriptional gene signature", also referred to herein as a "gene signature,” “expression signature,” “transcriptome,” “profile,” or “gene profile”, of PBCs, in particular of a PBC fraction comprising white blood cells, i.e., PBC-associated, and in particular granulocytes and optionally lymphocytes associated, transcriptional gene signatures, to determine whether a subject is suffering from a malignant ovarian tumor disease.
  • the present invention is also directed to the use of PBC-associated transcriptomes for the optional determination of whether a subject with an ovarian tumor is suffering from a
  • the present invention is based on the finding of PBC-associated and ovarian cancer-associated markers, specifically transcriptomes. The presence or the level of such markers as determined according to the invention specifically is indicative of malignant ovarian tumors.
  • the invention is based on the identification of PBC- and ovarian cancer-associated biomarkers, which may be grouped in a multimarker panel based on their utility in the diagnosis, prognosis, monitoring, and/or treatment of malignant ovarian tumor disease.
  • biomarker or “marker” includes a polynucleotide (e.g., gene, transcript, expressed sequence tag (EST), etc.) or polypeptide molecule that is substantially modulated (i.e., upregulated or downregulated) in quantity in peripheral blood cells of subjects, specifically human beings, with malignant ovarian tumor disease, including ovarian cancer of early or late stage, with high, medium or low metastatic potential as compared to a subject substantially free of such tumor (e.g. a healthy subject) or a subject suffering from a benign tumor.
  • a polynucleotide e.g., gene, transcript, expressed sequence tag (EST), etc.
  • polypeptide molecule that is substantially modulated (i.e., upregulated or downregulated) in quantity in peripheral blood cells of subjects, specifically human beings, with malignant ovarian tumor disease, including ovarian cancer of early or late stage, with high, medium or low metastatic potential as compared to a subject substantially free of such tumor (e.g. a healthy subject)
  • the PBC- associated biomarkers of the invention include the polynucleotides, their corresponding gene products, expression products and fragments, variants, such as splice variants or other functionally equivalent variants, homologs and isoforms thereof.
  • the individual markers of the multimarker panel are determined by preparing samples of mRNAs in the PBC sample or fraction, and determining the presence and/or level of the mRNAs.
  • beneficial biomarkers particularly refers to the individual markers of a panel that comprises at least NEAT1 , BC037918, C1 orf63, PRIC285, OSM, and optionally further genes or protein markers, such as at least one of the further genes B4GALT1 , CCR2, CFP, ZNF419, PAPOLG, NOXA1 , DIS3 and/or AP2A1 , which panel is herein also called multimarker panel or PBC multimarker panel.
  • the term shall also refer to the panel consisting of the genes NEAT1 , BC037918, C1 orf63, PRIC285, OSM, or alternatively consisting of the genes NEAT1 , BC037918, C1 orf63, PRIC285, OSM, DIS3 and CCR2, or alternatively consisting of the genes NEAT1 , BC037918, C1 orf63, PRIC285, OSM, B4GALT1 , CCR2, CFP, ZNF419, PAPOLG, NOXA1 , DIS3 and AP2A1 , alone or in combination with a panel of protein markers, such as a panel including at least one of CA-125, HE4, CEA, VCAM-1 , MIF, Leptin, Prolactin, OPN (osteopondin), IGF-II (IGF2), apolipoprotein A1 , transthyretin or truncated transthyretin, ITIH4, hepcidin, ⁇ 2- ⁇ ,
  • biomarkes of the invention are specifically of human origin and provided in Table 1 including the UniGene accession numbers, gene symbols and HUGO nomenclature, where applicable, and the directions of their modulation (i.e.
  • the biomarker panel according to the invention may be combined with further tests, e.g. to determine further PBC markers or markers of white blood cells, such as granulocyte or lymphocyte markers, or serum markers.
  • Preferred marker combinations are with those known to relate to ovarian cancer or more general to epithelial markers that are indicative of carcinomas. Any marker combination of at least the inventive genes and optionally one or more markers associated with cancer, which increases the selectivity and/or the sensitivity is considered a preferred combination to determine the risk of ovarian tumor disease.
  • biomarkers that are not associated with the disease, but stably expressed are determined as internal control, e.g. simultaneously, in parallel or consecutively within the same sample or the same type of sample, to obtain reference values for normalization of the expression levels to facilitate the comparison of test results.
  • the normalized level of gene expression in a test sample is then typically compared with the reference (external control) value that is usually obtained from healthy subjects or subjects with a benign tumor.
  • the biomarkers of the invention may be polynucleotides, their corresponding gene products, and fragments, homologs and isoforms thereof, that are substantially modulated (i.e. upregulated or downregulated) in PBCs of patients with malignant ovarian tumor disease compared to PBCs of subjects substantially free of such tumor and/or in PBCs of patients with a benign tumor.
  • Any differential expression of such biomarkers e.g. by upregulating or downregulating as compared to a reference, such as obtained from healthy subjects or subjects suffering from a benign tumor, might indicate a higher or lower risk of a malignant ovarian tumor disease.
  • a set of biomarkers or a “panel of biomarkers” also called
  • multimarker panel includes a set of polynucleotides, their corresponding gene products, including transcripts and proteins, and fragments, homologs and isoforms thereof that may be used to distinguish patients with malignant ovarian tumor disease from subjects substantially free of such tumor and/or patients with a benign tumor.
  • expression levels of the substantially modulated, i.e., upregulated or downregulated, PBC- associated biomarkers of the invention are respectively increased or decreased by an abnormal magnitude, wherein the level of expression is aberrant, e.g. outside the standard deviation for the same PBC- associated biomarker in PBCs from healthy subjects or from subjects suffering from a benign tumor.
  • the substantially modulated PBC- associated biomarker is upregulated or down regulated relative to a reference value by at least an aberrant 1 .5-, 2-, 3-, or 4-fold change or more. It is not necessary, that all of these markers alone are significantly up- or downregulated in each cancer sample.
  • a risk-score calculated with the coefficients provided in Table 3 (LASSO model), is preferably used for indicating the malignant disease.
  • PBC peripheral blood cells as found in samples of blood or other body fluids, in particular of human subjects, or immobilized on surfaces, in particular white blood cells, such as granulocytes or lymphocytes, but also peripheral blood mononuclear cells (PBMCs), e.g. obtained in a blood or other body fluid or fraction of such body fluid containing epithelial and/or mononuclear cells, preferably depleted from such epithelial cells or disseminated tumor cells and/or enriched in the white blood cells cells. It is feasible that such a PBC sample as used according to the invention is obtained from extracts of body fluids or tissues, which contain PBCs.
  • PBMCs peripheral blood mononuclear cells
  • PBC samples are usually taken from peripheral blood using cell separation techniques according to cell harvesting protocols, and are used either freshly prepared or in the frozen state.
  • a typical protocol for PBC fraction wherein a majority of white blood cells are mainly comprising granulocytes and lymphocytes, whole blood is collected by standardized venipuncture with anticoagulants and further processed. Briefly, blood samples are homogenized and processed by density- gradient centrifugation. Then a cell (RNA) lysis buffer is added to the isolated PBC fraction. The PBC lysates are used to extract total RNA immediately or after storage in the frozen state. The mRNA may then be tested according to standard protocols employing commercially available analytical tools with a specificity to determine the individual biomarkers (e.g. RT-qPCR, microarray technology, Next Generation
  • This gene encodes the alpha 1 adaptin subunit of the adaptor protein 2 (AP2 adaptors) complex found in clathrin coated vesicles.
  • the AP-2 complex is a heterotetramer consisting of two large adaptins (alpha or beta), a medium adaptin (mu), and a small adaptin (sigma).
  • the complex is part of the protein coat on the cytoplasmic face of coated vesicles which links clathrin to receptors in vesicles.
  • Alternative splicing of this gene results in two transcript variants encoding two different isoforms.
  • Adaptor protein complexes function in protein transport via transport vesicles in different membrane traffic pathways. Adaptor protein complexes are vesicle coat components and appear to be involved in cargo selection and vesicle formation.
  • B4GALT1 UDP-Gal:betaGlcNAc beta 1 ,4-galactosyltransferase
  • Beta-1 ,4-galactosyltransferase 1 is an enzyme that in humans is encoded by the B4GALT1 gene (UniProtKB: P15291 ), which belongs to the glycosyltransferase 7 family.
  • This gene is one of seven beta-1 ,4-galactosyltransferase (beta4GalT) genes. They encode type II membrane-bound glycoproteins that appear to have exclusive specificity for the donor substrate UDP-galactose; all transfer galactose in a beta1 ,4 linkage to similar acceptor sugars: GlcNAc, Glc, and Xyl.
  • beta4GalT has a distinct function in the biosynthesis of different glycoconjugates and saccharide structures. As type II membrane proteins, they have an N-terminal hydrophobic signal sequence that directs the protein to the Golgi apparatus and which then remains uncleaved to function as a transmembrane anchor.
  • the beta4GalTs form four groups: beta4GalT1 and beta4GalT2, beta4GalT3 and beta4GalT4, beta4GalT5 and beta4GalT6, and beta4GalT7. This gene is unique among the beta4GalT genes because it encodes an enzyme that participates both in glycoconjugate and lactose biosynthesis.
  • C1 orf63 corresponds to a protein coding transcript, whose gene product (hypothetical protein LOC57035) has an unknown function and has no homology to any other known protein.
  • CCR2 short for chemokine (C-C motif) receptor 2
  • CCR2 has also recently been designated CD192 (cluster of differentiation 192).
  • This gene (UniProtKB: P41597) encodes two isoforms of a receptor for monocyte chemoattractant protein-1 , a chemokine which specifically mediates monocyte chemotaxis.
  • Monocyte chemoattractant protein-1 is involved in monocyte infiltration in inflammatory diseases such as rheumatoid arthritis as well as in the inflammatory response against tumors.
  • the receptors encoded by this gene mediate agonist- dependent calcium mobilization and inhibition of adenylyl cyclase. This gene is located in the chemokine receptor gene cluster region. Two alternatively spliced transcript variants are expressed by the gene.
  • This gene encodes a plasma glycoprotein that positively regulates the alternative complement pathway of the innate immune system. This protein binds to many microbial surfaces and apoptotic cells and stabilizes the C3- and C5-convertase enzyme complexes in a feedback loop that ultimately leads to formation of the membrane attack complex and lysis of the target cell. Mutations in this gene result in two forms of properdin deficiency, which results in high susceptibility to meningococcal infections. Multiple alternatively spliced variants, encoding the same protein, have been identified.
  • Exosome complex exonuclease RRP44 (Ribosomal RNA-processing protein 44) or Dis3 is an enzyme that in humans is encoded by the DIS3 gene (UniProtKB:
  • Its protein product is an RNase enzyme homologous to the yeast protein Rrp44, and can be part of the exosome complex in the nucleus of eukaryotic cells.
  • NEAT1 non-protein coding RNA 84 (Gene ID: 283131)
  • NEAT1 refers to Nuclear Enriched Abundant Transcript 1 , a non-protein coding transcript
  • NOXA1 NADPH oxidase activator 1 (Gene ID: 10811)
  • NOXs NADPH oxidases
  • ROS reactive oxygen species
  • Oncostatin M also known as OSM, is a protein that in humans is encoded by the OSM gene (UniProtKB: P13725).
  • OSM is a pleiotropic cytokine that belongs to the interleukin 6 group of cytokines. Of these cytokines it most closely resembles leukemia inhibitory factor (LIF) in both structure and function. However, it is as yet poorly defined and is proving important in liver development, haematopoeisis, inflammation and possibly CNS development. It is also associated with bone formation and destruction.
  • LIF leukemia inhibitory factor
  • PAPOLG poly(A) polymerase gamma
  • Poly(A) polymerase gamma is an enzyme that in humans is encoded by the PAPOLG gene (UniProtKB: Q9BWT3). This gene encodes a member of the poly(A) polymerase family which catalyzes template-independent extension of the 3' end of a DNA/RNA strand. This enzyme shares 60% identity to the well characterized poly(A) polymerase II (PAPII) at the amino acid level. These two enzymes have similar organization of structural and functional domains. This enzyme is exclusively localized in the nucleus and exhibits nonspecific and CPSF (cleavage and polyadenylation specificity factor)/AAUAAA-dependent polyadenylation activity.
  • PAPOLG gene UniProtKB: Q9BWT3
  • PAPII poly(A) polymerase II
  • PRIC285 peroxisomal proliferator-activated receptor A interacting complex 285, synonyms: KIAA1769, PRIC COMPLEX 285-KD SUBUNIT , PPAR- GAMMA DNA-BINDING DOMAIN-INTERACTING PROTEIN 1 (PDIP1), PDIP1 - ALPHA, PDIP1 -BETA; (see SEQ ID 2 providing mRNA sequence information, transcript variant 1 , including other variants possibly used, human)
  • the protein encoded by this gene is a nuclear transcriptional co-activator for peroxisome proliferator activated receptor alpha.
  • the encoded protein contains a zinc finger and is a helicase that appears to be part of the peroxisome proliferator activated receptor alpha interacting complex. This gene is a member of the DNA2/NAM7 helicase gene family.
  • ZNF419 zinc finger protein 419 (Gene ID: 79744)
  • ZNF419 codes for a Zn-finger protein (UniProtKB: Q59FT8), propably involved in gene regulation.
  • BC037918 (no ORF in transcript BC037918, see SEQ ID 1 providing cDNA sequence information, human)
  • Transcript BC037918 has no open reading frame (ORF) and seems to be an untranslated transcript.
  • ORF open reading frame
  • RPL21 Ribosomal protein L21 (Gene ID: 6144)
  • 60S ribosomal protein L21 is a protein that in humans is encoded by the RPL21 gene. Ribosomes, the organelles that catalyze protein synthesis, consist of a small 40S subunit and a large 60S subunit. Together these subunits are composed of 4 RNA species and approximately 80 structurally distinct proteins. This gene encodes a ribosomal protein that is a component of the 60S subunit. The protein belongs to the L21 E family of ribosomal proteins. It is located in the cytoplasm.
  • This gene encodes a ribosomal protein that is a component of the 60S subunit.
  • the protein belongs to the L6P family of ribosomal proteins. It is located in the cytoplasm. As is typical for genes encoding ribosomal proteins, there are multiple processed pseudogenes of this gene dispersed through the genome. Two alternatively spliced transcript variants encoding the same protein have been found for this gene.
  • SH3BGRL3 SH3 domain-binding glutamic acid-rich-like protein 3 (Gene ID: 83442)
  • SH3BGL3 (UniProtKB: SH3L3_HUMAN, Q9H299) could act as a modulator of glutaredoxin biological activity.
  • subject shall refer to any mammal, in particular a human, but also selected from animals, such as those used for tumor models and other animal studies.
  • the subject shall be human beings who are patients at risk of developing a tumor.
  • inventive biomarkers are preferably human biomarkers.
  • patient as used herein always includes healthy subjects.
  • malignant ovarian tumor disease shall refer to any pathologic condition resulting from a malignant ovarian tumor, such as cancer, including the various stages FIGO I, II, III and IV, a proliferating disease, metastasis, and refractory or recurrent disease.
  • FIGO - International Federation of Gynecology and Obstetrics - ovarian cancer surgical staging system is based on Roman numerals as well as letters to designate sub-stages. In general, prognosis depends more upon the main stage. However, the sub-stages can also be important in deciding between treatment recommendations.
  • Stage I - The cancer is limited to the ovaries
  • IA - Limited to one ovary and the outer ovarian capsule is not ruptured. There is no tumor on the external surface of the ovary and there is no ascites and/or the washings are negative.
  • IB - Cancer is present in both ovaries, but the outer capsule is intact and there is no tumor on external surface. There is no ascites and the washings are negative.
  • IC - The cancer is either Stage IA or IB level but the capsule is ruptured or there is tumor on the ovarian surface or malignant cells are present in ascites or washings.
  • Stage II - Cancer involves one or both ovaries with spread to other pelvic organs or surfaces.
  • the washings are negative washings and there is no ascites.
  • I IIA - Tumor is grossly confined to the pelvis but with microscopic peritoneal metastases beyond pelvis to abdominal peritoneal surfaces or the omentum.
  • NIB Same as I IIA but with macro-scopic peritoneal or omental metastases beyond pelvis less than 2 cm in size.
  • NIC Same as I IIA but with peritoneal or omental metastases beyond pelvis, larger than 2 cm or lymph node metastases to inguinal, pelvic, or para-aortic areas.
  • LMP Low malignant potential
  • precancerous cells cells that may or that are likely to become cancerous
  • precancerous cells exist, but these tumors are characterized by the absence of ovarian stromal invasion, and yet they retain the ability to metastasize.
  • LMP tumors are defined as cystadenomas with proliferative activity of the epithelial cells and nuclear abnormalities, but with no infiltrative destructive growth, and they seem to be a distinct class of tumors, usually do not advance to malign carcinomas.
  • the term "at risk of a disease such as malignant ovarian tumor disease as used herein shall refer to a subject that potentially develops such a disease or already suffers from such a disease at various stages, including the early stage and advanced disease state, particularly associated with malignant tumors.
  • the risk determination to diagnose a malignant ovarian tumor is particularly important in a subject, where the malignancy has not yet been diagnosed. This risk determination therefore includes early stage diagnosis.
  • those patients are tested for the biomarkers according to the invention, before an ovarian tumor is detected, or before malignancy has proven by biopsy.
  • Antecedent diseases such as cancer, or benign tumors or certain medical treatment would also increase the risk of developing solid tumors and associated disease conditions.
  • ovarian tumors that classify a high cancer risk have been identified so far, among them familial history of breast, uterus, colon or ovarian cancer, BRCA1 or BRCA2 gene mutations, hormonal therapies, never pregnant, probably obesity and use of fertility drugs.
  • the early detection of a malignant ovarian tumor disease is essential in the patient population that is already classified as high-risk patients. It is thus preferred to test a patient population according to the invention, which is already classified as risk patients.
  • the inventive method allows the early stage determination of the ovarian tumor disease or respective risk stages, e.g. to distinguish between low, medium and high risk patients.
  • determination according to the invention particularly refers to the prognosis of a subject to develop cancer and/or the prognosis of a cancer patient, and in particular to the determination of the metastatic potential, such as tumors with low, medium or high metastatic potential.
  • the method is a non-invasive method for the in vitro or ex vivo diagnosis of the malignant ovarian tumor disease; in particular the invention provides for the non-invasive, non-surgical method for detection, diagnosis, monitoring, or prediction of ovarian cancer or onset of ovarian cancer in a patient.
  • the invention preferably contemplates a gene expression profile comprising the multimarker panel according to the invention. This profile provides a highly sensitive and specific test with both high positive and negative predictive values permitting diagnosis and prediction of the patient's risk of developing cancer or the risk of developing metastatic disease.
  • the present invention specifically provides for the inventive gene signature derived from the expression in PBCs for the early diagnosis of ovarian cancer with high specificity and sensitivity.
  • LMP tumors and cystadenomas are possibly diagnosed as benign tumors or not diagnosed as malignant tumors.
  • the preferred specificity of the method according to the invention is at least
  • the sensitivity preferably is at least 70%, preferably at least 74%, specifically ranging between 85% and 90%, at a high specificity, such as the specificity of at least 99%. Therefore, a highly reliable test for diagnosing ovarian cancer, even in the early stages FIGO I and/ or II is provided.
  • peripheral blood mononuclear cells were isolated from epithelial ovarian cancer (EOC) patients and healthy blood donors as controls and used a whole genome transcriptomics approach (Applied Biosystems Human Genome Survey microarrays V2.0) to find gene expression patterns to discriminate between ovarian cancer patients and healthy controls or patients with non-malignant diseases.
  • EOC epithelial ovarian cancer
  • V2.0 whole genome transcriptomics approach
  • a predictive model was built from a large cohort of patients and controls using RT-qPCR derived expression values of selected gene panels, which were validated by means of the bootstrap .632+ cross-validation method.
  • the bootstrap validated model showed an area under the ROC curve (AUC) of 0.967 and a classification error of 16.4%. This corresponds to a sensitivity of 88% at specificity of 99%.
  • the analytical system to determine the expression of the multimarker gene panel typically employs a detection system.
  • detect includes assaying, imaging or otherwise establishing the presence or absence of the target biomarker.
  • the level of biomarkers or amount of biomarkers is herein understood to refer to the respective polypeptides or nucleotide sequence, including variants such as splice variants, subunits thereof, or reagent bound targets.
  • the target biomarker is preferably determined by testing for the respective polypeptides and/or polynucleotides indicative of marker expression.
  • the expressed marker is detectable e.g. as polynucleotide, like mRNA, or expressed polypeptide or protein. The comparison with the reference value should be of the same sample type.
  • the reagents preferably comprise ligands specifically binding to the biomarker polypeptide or gene or genetic marker, e.g. comprising a plurality of respective polypeptides, genes or polynucleotides. Ligands are herein understood as marker specific moieties.
  • the reagents are provided in suitable kits. Therefore, the invention also relates to kits for carrying out the methods of the invention.
  • the invention specifically contemplates the methods, compositions, and kits described herein using the inventive markers and further additional markers associated with ovarian or other epithelial cancer or used as normalization or control markers.
  • the methods described herein may be modified by including reagents to detect the inventive markers and optionally additional markers, including polynucleotides for the markers.
  • Marker specific moieties are substances which can bind to or detect at least one of the markers for a detection method described above and are in particular marker nucleotide sequence detecting tools or marker protein specific antibodies, including antibody fragments, such as Fab, F(ab), F(ab)', Fv, scFv, or single chain antibodies.
  • the marker specific moieties can also be selected from marker nucleotide sequence specific oligonucleotides, which specifically bind to a portion of the marker sequences, e.g. mRNA or cDNA, or are complementary to such a portion in the sense or complementary anti-sense, like cDNA complementary strand, orientation.
  • a set of reagents to determine the biomarker panel includes diagnostic tools, such as ligands to specifically bind the gene expression products or amplification products, e.g. through ligand affinity binding or hybridization of a nucleotide sequence.
  • diagnostic tools such as ligands to specifically bind the gene expression products or amplification products, e.g. through ligand affinity binding or hybridization of a nucleotide sequence.
  • the preferred set employs primers to perform a PCR analysis to amplify each of the marker sequences of the inventive biomarkers, and means to detect or visualize the amplification products, including hybridizing probes.
  • affinity ligands to bind the respective polypeptides, such as receptors, antibodies, antibody fragments, peptides or proteins.
  • the preferred ligands may be attached to solid surfaces to catch and separate the marker or PBC in the sample, optionally together with a label.
  • Biological assays require methods for detection, and one of the most common methods for quantitation of results is to conjugate a detectable label to a protein or nucleic acid that has affinity for one of the components in the biological system being studied.
  • Detectable labels may include molecules that are themselves detectable (e.g., fluorescent moieties, electrochemical labels, metal chelates, etc.) as well as molecules that may be indirectly detected by production of a detectable reaction product (e.g., enzymes such as horseradish peroxidase, alkaline phosphatase, etc.) or by a specific binding molecule which itself may be detectable (e.g., biotin, digoxigenin, maltose,
  • oligohistidine 2,4-dintrobenzene, phenylarsenate, ssDNA, dsDNA, etc.
  • the methods described herein utilize the multimarker panel placed on a microarray so that the expression status of each of the markers is assessed simultaneously.
  • the invention provides a microarray as a diagnostic tool comprising a defined set of ligands to the marker genes.
  • the preferred microarray is provided on a single carrier that includes the means to react with the inventive biomarkers, which are preferably spatially separated. The reaction products may then be separately detected in a one-step procedure.
  • the mRNA concentration of the markers is
  • mRNA of the sample can be isolated, if necessary, after adequate sample preparation steps, e.g. PBC enrichment for white blood cells and/or lysis, and detected with marker specific probes, in particular on a microarray with or without amplification, e.g. employing primers for PCR-based detection methods, such as PCR extension labelling with probes specific for a portion of the marker mRNA.
  • the invention provides a method for determining the risk of malignant ovarian tumor disease in a subject comprising
  • oligonucleotides each specifically hybridizing with a control marker selected from the group consisting of RPL21 , RPL9 and SH3BGRL3,
  • the amount of mRNA is detected via polymerase chain reaction using, for example, oligonucleotide primers that hybridize to a marker gene, or complements of such polynucleotides.
  • the method may be carried out by combining isolated mRNA with reagents to convert to cDNA according to standard methods and analyzing the products to detect the marker presence in the sample.
  • the genomic nucleic acid may be analyzed for the specific marker expression.
  • marker specific tools such as primers for PCR amplification and probes to hybridize with the relevant nucleotide sequence
  • the amount of a marker or any combination thereof is determined by the polypeptide or protein concentration of the marker(s), e.g. using marker specific ligands.
  • the binding event can, e.g., be detected by competitive or non-competitive methods, including the use of labelled ligand or marker specific moieties or labelled competitive moieties, e.g. including a labelled marker standard, which compete with marker proteins for the binding event. If the marker specific ligand is capable of forming a complex with the marker, the complex formation indicates expression of the markers in the sample.
  • the invention relates to a method for diagnosing and monitoring malignant ovarian tumor disease in a patient by quantitating a marker in a PBC sample, optionally employing a PBC fraction, from the patient comprising
  • binding agents each specifically binding to a marker of the multimarker panel according to the invention, which binding agent is directly or indirectly labelled with a detectable substance
  • immunoassays involve contacting a sample potentially containing a biomarker of interest with at least one immunoligand that specifically binds to the marker.
  • competitive immunoassays employing binding moieties that compete with the binding of the marker to its ligand may be employed.
  • a signal is then generated indicative of the presence or amount of complexes formed by the binding of polypeptides in the sample to the ligand.
  • the signal is then related to the presence or amount of the marker in the sample.
  • Immunoassays and respective tools for determining the markers of the inventive multimarker panels are well-known in the art or can be prepared using well- known techniques.
  • the ligands with specificity to bind the individual polypeptides or proteins of the inventive biomarkers can be prepared according to standard techniques or obtained from commercial sources, such as supplier of antibodies, e.g. Abeam pic (330 Cambridge Science Park, Cambridge, CB4 0FL, UK), Santa Cruz Biotechnology, Inc. (2145 Delaware Avenue, Santa Cruz, CA. 95060, USA), Lifespan Biosciences, Inc. (2401 Fourth Avenue, Suite 900, Seattle, WA 98121 , USA), Novus Biologicals, LLC (8100 Southpark Way, A-8, Littleton, CO 80120, USA).
  • the differential marker expression is determined by comparing the expression to the control of healthy subjects or patients suffering from a benign tumor.
  • Reference values for the biomarker determination are preferably obtained from a control group of subjects with normal expression of said biomarker, or a biomarker expression, that is associated with the disease condition, such as disease stages, which represents the appropriate reference value.
  • the control comprises material derived from a pool of samples from normal subjects.
  • the normal level of a biomarker may be determined in samples of the same type obtained from control subjects.
  • the reference values are typically calculated from standard deviations of the mean average marker expression in healthy subjects. If more than one marker is detected, the comparison is made to each single reference value for each marker in the reference itself.
  • the malignant ovarian tumor disease may be diagnosed if the amount of the biomarker or the combination of markers exceeds the cut-off value determined according the preferred specificity of 99% or a sensitifity of 99%.
  • the risk score is preferably calculated according to a logistic regression model, such as provided in Table 3 below. As a reference the value of subjects not suffering from such tumor, preferably being subjects from a control group or healthy subjects, is used. If at least two biomarkers of the panel according to the invention differ from the reference value, the risk is considered to be increased as well.
  • the marker level can also be compared to a threshold, e.g. a cut-off
  • biomarker concentration and the risk of the ovarian tumor development is determined from such comparison; wherein the biomarker concentration above (upregulated) or below (downregulated) the reference value is predictive of tumor development in the patient.
  • the preferred method according to the invention comprises the step of comparing the biomarker level with a predetermined standard or cut-off value, which is preferably at least 25% different from the standard, more preferred at least 40% or 50% different, but can also be at least 100% different.
  • a predetermined standard or cut-off value which is preferably at least 25% different from the standard, more preferred at least 40% or 50% different, but can also be at least 100% different.
  • the typical gene signature of the multimarker panel according to the invention indicates, for example, special treatment of the patient, using appropriate medication or further diagnostic techniques, such as imaging and surgical interventions. The method of the invention can thus be used to evaluate a patient before, during, and after medical treatment.
  • Types of cancer treatment that are used as adjuvant therapy include
  • the cancer patient can be determined for the metastatic potential to decide about a second line adjuvant treatment.
  • the preferred method of determining the gene signature of a PBC sample of a patient employing the multimarker panel according to the invention may also be particularly useful to monitor the marker level during such treatment.
  • a peripheral blood fraction enriched in PBC specifically the PBC fraction enriched in lymphocytes and granulocytes, and depleted from epithelial cells were isolated from EDTA-blood according to Brandt and Griwatz (Clin Chem I1996;42:
  • microarray gene expression measurements of the selected genes were validated by real time PCR.
  • cDNA was synthesized from 1 ⁇ g total RNA using the M- MLV reverse transcriptase (Promega, Madison, Wl, USA) and a random nonamer primer.
  • the log 2 expression values were compared between healthy and malignant tumor samples by the significance analysis of microarrays (SAM) procedure, employing the t test statistic and using R's samr package (Tusher VG et al. Proc Natl Acad Sci U S A 2001 ;98: 51 16-21 ). Genes with q-values less than 0.15 were selected for model building and validation. In the last step, the genes selected by the SAM procedure were re-assessed by RT-qPCR in all 239 malignant, 90 healthy, and 14 low- malignant potential or benign samples.
  • SAM microarrays
  • BC037918 both non-coding RNAs
  • CCR2 CCR2
  • Three genes were not significantly different expressed in both groups (B4GALT1 , DIS3 and ZNF419). All other genes were significantly down-regulated in the EOC patients compared to the controls (Table 1 ).
  • Table 4 the corresponding area under the receiver operating characteristic (ROC)-curve (AUC) values for all 13 genes using 90 healthy blood donors as controls and the 239 epithelial ovarian cancer patients are shown.
  • the expression of five genes was associated with higher probability of EOC, two of them non-significantly (again DIS3 and ZNF419), and eight genes were negatively correlated with the probability of EOC. The latter were therefore inverted for the ROC curves and AUC estimations (cf.
  • Table 4 The bootstrap .632+ estimate of classification error was 16.4%.
  • FIGO l/l I EOC tumors were different from benign or LMP tumors with an AUC of 0.853 (95% CI 0.719 - 0.987) (Fig. 2F, Table 3).
  • the risk score was calculated as follows:
  • Risk-score ( 1.241 * CFP ) + ( -0.888 * NOXA1 ) + ( 2.075 * NEAT1 ) + ( 0.035 * BC037918 ) + ( 1 .177 * DIS3 ) + ( 0.145 * ZNF419 ) + ( 0.376 * CCR2 ) + ( -0.642 * B4GALT1 ) + ( -0.454 * PAPOLG ) + ( -1 .794 * PRIC285 ) +
  • the LASSO model was used as described in Mee Young Park and Trevor Hastie (2007) L1 regularization path algorithm for generalized linear models. (J. R. Statist. Soc. B, 69, 659-677).
  • FIGO l/l I 0.905 ⁇ 0.001 0.781 1 .000
  • the L1 model comprised of five gene expressions (228089: NEAT1 ; 713562: BC037918; 157342: C1 orf63; 162222: PRIC285; 205406: OSM) and 5 serum protein values (0.63 * 228089 + 0.22 * 713562 + 0.35 * 157342 -1 .58 * 162222 - 0.54 * 205406 - 0.054 * lg2_MIF + 0.47 * lg2_Prolactin + 0.33 * lg2_CA125 -0.55 * lg2_Leptin - 0.47 * lg2_IGF2 + 4.91 ) showed a sensitivity of about 98% at a specificity fixed at 99.6%.
  • Peripheral blood cells such as the white blood cell fractionseem to be an informative blood compartment for early diagnosis of epithelial ovarian cancer.
  • the diagnostic power is similar to marker panels derived from serum proteins.
  • the expression pattern of five genes, optionally together with further genes such as the selected genes in PBCs can discriminate healthy controls from epithelial ovarian cancer patients, e.g. with a validated classification error of 16.4%.
  • our model can distinguish benign or low malignant potential tumors from malignant tumors with a rather high sensitivity and specificity (at least 87% and 95%, respectively), probably useful for differential diagnosis, which has a tremendous impact on treatment needs and prognosis.
  • the other protein functions are completely incoherent: one is a zinc-finger protein (ZNF419) of unknown function, one a poly(A) polymerase (PAPOLG), one a co- activator for several nuclear receptors like PPARA, PPARG, TR-beta-1 , ER-alpha, and RXR-alpha (PRIC285), one an activator of catabolic NADPH oxidases (NOXA1 ), one is an RNase enzyme and can be part of the exosome complex (DIS3), and one is involved in the assembly of clathrin coated vesicles (AP2A1 ). From one transcript, C1 orf63, no homologue protein is known.
  • the PBC-expression based test according to the invention can be further improved by serum protein based tests, such as the commercial available OVA1TM test offered by Quest Diagnostics in the USA or the protein panel described by Visintin et al. (Visintin I et al. Clin Cancer Res 2008;14: 1065-72), which could allow real detection of ovarian cancer with a near 100% sensitivity and specificity.
  • serum protein based tests such as the commercial available OVA1TM test offered by Quest Diagnostics in the USA or the protein panel described by Visintin et al. (Visintin I et al. Clin Cancer Res 2008;14: 1065-72), which could allow real detection of ovarian cancer with a near 100% sensitivity and specificity.

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